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首页> 外文期刊>neurosurgical focus >Real-time navigation guidance with intraoperative CT imaging for pedicle screw placement using an augmented reality head-mounted display: a proof-of-concept study
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Real-time navigation guidance with intraoperative CT imaging for pedicle screw placement using an augmented reality head-mounted display: a proof-of-concept study

机译：使用增强现实头戴式显示器进行术中 CT 成像的椎弓根螺钉放置的实时导航引导：一项概念验证研究

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OBJECTIVE Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon's field of view, and to assess screw placement accuracy via this method. METHODS Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2–5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected. RESULTS Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4 (192 screws). Accuracy for attendings and trainees was 99.1 (112 screws) and 97.5 (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1 vs 94.32; p = 0.0212) and all users (98.4 vs 94.32; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive. CONCLUSIONS Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience.
机译：目标 增强现实 （AR） 有可能提高脊柱融合手术中器械放置的准确性和效率，提高患者安全性和结果，优化手术室的人体工程学，并最终降低手术成本。作者试图描述商业原型脊柱AR平台（SpineAR）的使用，该平台为导航引导的脊柱手术提供商业AR头戴式显示器（ARHMD）用户界面，将术中成像的实时导航图像与外科医生视野中的3D重建模型相结合，并通过这种方法评估螺钉放置精度。方法 评估椎弓根螺钉放置精度，并与文献报道的徒手 （FH） 技术数据进行比较。还比较了不同脊柱手术经验的参与者之间使用 SpineAR 的准确性。11 名没有 AR 辅助椎弓根螺钉放置经验的操作员参加了这项研究：5 名主治神经外科医生和 6 名实习生（1 名神经外科研究员、1 名高级骨科住院医师、3 名神经外科住院医师和 1 名医学生）。市售的3D打印腰椎模型被用作人体解剖学的替代品。在操作者中，共有 192 个螺钉在 24 个腰椎模型中使用 SpineAR 从 L2-5 进行双侧仪器化。除一名学员外，所有学员也都使用 FH 方法插入了 8 颗螺钉。除了使用Gertzbein-Robbins分级量表进行准确性评分外，还评估了轴向轨迹，并收集了用户对SpineAR体验的反馈。结果 基于Gertzbein-Robbins分级量表，所有用户使用SpineAR的总体螺钉放置准确率为98.4%（192个螺钉）。参会者和受训者的准确率分别为 99.1%（112 颗螺丝钉）和 97.5%（80 颗螺丝钉）。与文献报道的腰椎螺钉放置准确率相比，使用FH对就诊（99.1% vs 94.32%;p = 0.0212）和所有用户（98.4% vs 94.32%;p = 0.0099）的准确率更高。内侧角度最小为 5° 的总插入螺钉百分比为 100%。在参加者和受训者之间或两种方法之间没有观察到差异。用户对SpineAR的反馈总体上是积极的。结论 使用 SpineAR 进行螺钉放置是可行且准确的，SpineAR 是一个具有实时导航指导的 ARHMD 平台，提供了良好的外科医生用户体验。

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